Role of Cartilage Surgery and Hip Arthroscopy in the Management of Early Hip Arthritis: Current Concepts

Abstract Capsulotomy in different modalities has been used to provide adequate exposure to access both the central and peripheral compartment in hip arthroscopy. Even though the hip joint has inherent bony stability, soft tissue restraints may be important in patients with ligaments hyperlaxity or in some cases with diminished bony stability. Biomechanical studies and clinical outcomes have shown the relevant role of the capsule in hip stability, mainly the role of the iliofemoral ligament. Although is not very common, iatrogenic post-arthroscopy subluxation and dislocation have been reported and many surgeons are concerned about the role aggressive capsulotomy or capsulectomy in this situation, thus capsule repair has become very popular. We present a novel technique to access the hip without cutting the iliofemoral ligament. With this technique we can obtain adequate arthroscopic access to the hip joint in order to treat adequately the central compartment pathologies reducing the risk of iatrogenic post-operative hip instability.

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The Role of Hip Arthroscopy in the Management of Acute Arthritis of Hip

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00117 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0011

Author(s):

Sheung Tung Ho ◽

Hoi Yeung Ip ◽

Ming Yu Chiu ◽

Sze Hung Wong

Keyword(s):

Septic Arthritis ◽

Hip Arthroscopy ◽

Vastus Lateralis ◽

Positive Culture ◽

Good Alternative ◽

Postoperative Recovery ◽

Hip Pain ◽

Joint Fluid ◽

Delayed Treatment ◽

Hip Arthritis

Septic arthritis of hip is an orthopaedic emergency requiring early diagnosis and prompt surgical treatment to avoid grave complications like avascular necrosis and chondrolysis and post-infectious arthrosis. This is a retrospective review of 9 patients who underwent hip arthroscopy for suspected septic arthritis of hip from 2012 to 2018. Medical charts were reviewed to determine the efficacy of the use of hip arthroscopy in the diagnosis and treatment of acute hip arthritis. The age of patients ranged from 9 to 82. The mean follow-up was 29 months (1 to 49). All presented with hip pain and effusion in imaging by CT scan or ultrasonography. Fever was present in 5 out of 9 patients. Hip arthroscopy with 2 portals technique and joint lavage +/- debridement was done. Two patients had whitish suspension in the joint fluid and pathology confirmed pseudogout of hip. The remaining 7 patients were diagnosed and treated as septic hip arthritis. Only 3 had positive culture, probably related to the prior use of antibiotics. All except one responds well to arthroscopic debridement and lavage with infection eradicated, good hip motion and hip function. One patient of delayed treatment (2 weeks after onset of hip pain) had ongoing infection, requiring further arthrotomy and Girdlestone operation for uncontrolled hip infection with intramuscular abscess of vastus lateralis. Hip arthroscopy is a useful diagnostic tool in acute hip arthritis. Besides septic arthritis, monoarticular attack of psuedogout is an important differential diagnosis of acute hip pain in elderly. Early hip arthroscopy can result in rapid postoperative recovery. Arthroscopic lavage and debridement is safe and a good alternative to open arthrotomy in hip septic arthritis.

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